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Rieken S, Kronziel LL, Langer T, Rades D, Boppel T, Trillenberg P, Gebauer J. Proposal of a diagnostic algorithm for radiation-induced dropped head syndrome in long-term childhood cancer survivors based on a prospective study in a specialized clinical setting and a review of the literature. J Cancer Res Clin Oncol 2023; 149:17865-17879. [PMID: 37947868 PMCID: PMC10725355 DOI: 10.1007/s00432-023-05480-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 10/14/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE To prospectively assess the incidence of Dropped Head Syndrome (DHS) in childhood cancer survivors (CCS) and to develop and evaluate a diagnostic algorithm for DHS. METHODS A systematic literature search for DHS in combination with neck radiotherapy (RT) exposure was performed. Analyses and a combination of the most common examination methods were integrated into a diagnostic algorithm. Almost all CCSs visiting the local late effects clinic between May 2020 and April 2022 were included in the study. CCS exposed to neck RT with doses ≥ 19 Gy received standardized clinical and neurological assessment and, in case of abnormal results, an MRI scan to confirm muscle atrophy. RESULTS Two hundred and five CCS were included of whom 41 received RT to the neck with ≥ 19 Gy. In the entire cohort and in the subgroup receiving RT, 2.4% and 12% of CCS were affected by DHS, respectively. Results of clinical and neurological assessment correlated well with MRI results. Neck circumference and neck/thigh ratio were lower after neck RT. Over 50% of CCS experienced neck disability and pain. CONCLUSIONS A relevant proportion of CCS exposed to neck RT is affected by DHS. High concordance of MRI results with the neurological examination supports the clinical value of the diagnostic algorithm. Measurement of neck circumference might be an easy tool for assessment of neck muscle atrophy in survivors at risk. IMPLICATIONS FOR CANCER SURVIVORS Integration of a diagnostic algorithm for DHS in standard long-term follow-up care facilitates diagnosis as well as initiation of early treatment and obviates the need for invasive examinations.
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Affiliation(s)
- Sarah Rieken
- Department of Oncology and Hematology, University Medical Center Schleswig-Holstein, Ratzeburger Allee 160, 23538, Luebeck, Germany
| | - Lea Louisa Kronziel
- Institute of Medical Biometry and Statistics, University of Luebeck, Luebeck, Germany
| | - Thorsten Langer
- Department of Pediatric Oncology and Hematology, University Medical Center Schleswig-Holstein, Ratzeburger Allee 160, 23538, Luebeck, Germany
| | - Dirk Rades
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Ratzeburger Allee 160, 23538, Luebeck, Germany
| | - Tobias Boppel
- Department of Neuroradiology, University Medical Center Schleswig-Holstein, Ratzeburger Allee 160, 23538, Luebeck, Germany
| | - Peter Trillenberg
- Department of Neurology, University Medical Center Schleswig-Holstein, Ratzeburger Allee 160, 23538, Luebeck, Germany
| | - Judith Gebauer
- Department of Internal Medicine I, University Medical Center Schleswig-Holstein, Ratzeburger Allee 160, 23538, Luebeck, Germany.
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Felong TJ, Balos LL, Silvestri NJ. Testosterone Therapy for Dropped Head Syndrome: A Case Report. J Clin Neuromuscul Dis 2022; 24:98-102. [PMID: 36409341 DOI: 10.1097/cnd.0000000000000372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Dropped head syndrome (DHS) is an impairment of neck extension resulting in a chin-on-chest deformity. DHS is rarely seen but a major hindrance to daily function in affected patients. DHS has been associated with movement disorders, neuromuscular disorders, and electrolyte and endocrine abnormalities. DHS has also been seen in survivors of Hodgkin lymphoma (HL) years after irradiation. HL survivors are also at risk for endocrine hypogonadism after chemotherapy. We present the case of a 58-year-old male HL survivor with dropped head and limited strength in his atrophic neck extensor muscles. Laboratory testing and imaging, nerve conduction studies, electromyography, and muscle biopsy of the neck extensors revealed myopathic and neurogenic changes. Conservative management was unsuccessful. With a desire to avoid surgical fixation, he asked his primary care physician to check his testosterone levels, which returned as low normal. Within 4 months of starting testosterone therapy, he no longer experienced dropped head.
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Affiliation(s)
| | - Lucia L Balos
- Pathology and Anatomical Sciences, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY
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3
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Clinical and Pathological Profiles of Vertebral Bone Metastases from Endometrial Cancers: Evidence from a Twenty-Year Case Series. Diagnostics (Basel) 2022; 12:diagnostics12122941. [PMID: 36552950 PMCID: PMC9776595 DOI: 10.3390/diagnostics12122941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/09/2022] [Accepted: 11/22/2022] [Indexed: 11/26/2022] Open
Abstract
Patients with endometrial cancer (EC) frequently have metastases to lungs, extra-pelvic nodes, and liver. Although an uncommon occurrence, cases of EC metastasis to bone, prevalently in vertebral bone, have also been reported. The objective of this study was to analyze clinical and pathological profiles of patients with EC metastatic to vertebral bone. We carried out a retrospective case series on surgically treated patients for this pathology. From 2001 to 2021, out of 775 patients with bone metastasis, 1.6% had bone metastasis from EC. The median time between the diagnosis of primary tumor and that of bone metastases was 31.5 months. Solitary bone lesion was present in 7 patients and lumbar vertebrae were the segments most affected. Pathological fractures in 46.2% of patients and spinal pain in all were present. In terms of location, 46.2% of bone metastases resided within the anterior section of the vertebra, while the remaining presented an extension within the anterior and posterior sections, with 46.1% of cases showing an extradural extra-osseous extension and paraspinous envelope. Median survival after diagnosis of bone metastasis was 11.5 months. Vertebral bone metastasis in EC is a rare phenomenon, with severe prognosis. An in-depth understanding of this topic may guide future management and treatment decisions, thus improving life expectancy and quality.
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Inoue R, Sawamura M, Yoshimura M, Takahashi R. Dropped head syndrome due to chemoradiotherapy for nasal lymphoma, characterised by short tau inversion recovery high signal intensity in the cervical paraspinal muscles. BMJ Case Rep 2022; 15:e252446. [PMID: 36368727 PMCID: PMC9660595 DOI: 10.1136/bcr-2022-252446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ryoichi Inoue
- Department of Neurology, Graduate School of Medicine and Faculty of Medicine, Kyoto University, Kyoto, Japan
| | - Masanori Sawamura
- Department of Neurology, Graduate School of Medicine and Faculty of Medicine, Kyoto University, Kyoto, Japan
| | - Michio Yoshimura
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Hospital, Kyoto, Japan
| | - Ryosuke Takahashi
- Department of Neurology, Graduate School of Medicine and Faculty of Medicine, Kyoto University, Kyoto, Japan
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Zhao P, Xia W, Wei J, Feng Y, Xie M, Niu Z, Liu H, Ke S, Liu H, Tang A, He G. An Investigation of the Mechanisms of Radiation-Induced Muscle Injury in a Tree Shrew ( Tupaia belangeri) Model. Dose Response 2022; 20:15593258221082878. [PMID: 35360454 PMCID: PMC8961377 DOI: 10.1177/15593258221082878] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Animal models suitable for investigating mechanisms behind radiation-induced
muscle injury are lacking. We developed a tree shrew model of such injury
and investigated pathological changes and mechanisms. Methods Animals were divided into control (n = 5), radiation-induced acute injury (n
= 5), and radiation-induced chronic injury (n = 5) groups. Tensor veli
palatini (TVP) muscles of acute injury and chronic injury groups were
dissected under a microscope at 1 and 24 weeks after radiation therapy,
respectively. TVP muscles were stained with HE and Masson to visualize
pathological changes. ELISA was performed to measure oxidative injury.
RT-qPCR and immunohistochemical staining was performed to measure expression
levels of miR-206 and histone deacetylase 4 (HDAC4). Results Compared to the control group, acute injury group showed a significant
decrease in miR-206 expression (.061 ± .38, P < .05) and a significant
increase in HDAC4 expression (37.05 ± 20.68, P < .05). Chronic injury
group showed a significant decrease in miR-206 expression (.23 ± .19, P <
.05) and a significant increase in HDAC4 expression (9.66 ± 6.12, P
< .05). Discussion A tree shrew model of radiation-induced muscle injury was established by
exposing TVP muscle region to radiation of 20-Gy. Experimental results
indicated that injury caused by radiation persisted despite gradual healing
of the TVP muscle and miR-206 regulatory pathway plays a key role in
regulating radiation-induced muscle injury.
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Affiliation(s)
- Pengcheng Zhao
- Department of Otolaryngology–Head and Neck Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor, Ministry of Education, Nanning, China
| | - Wei Xia
- Department of Otolaryngology–Head and Neck Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor, Ministry of Education, Nanning, China
| | - Jianglian Wei
- Department of Otolaryngology–Head and Neck Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor, Ministry of Education, Nanning, China
| | - Yiwei Feng
- Department of Otolaryngology–Head and Neck Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor, Ministry of Education, Nanning, China
| | - Mao Xie
- Department of Otolaryngology–Head and Neck Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor, Ministry of Education, Nanning, China
| | - Zhijie Niu
- Department of Otolaryngology–Head and Neck Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor, Ministry of Education, Nanning, China
| | - Heng Liu
- School of Information and Management, Guangxi Medical University, Nanning, China
| | - Shenghui Ke
- Department of Otolaryngology–Head and Neck Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor, Ministry of Education, Nanning, China
| | - Huayu Liu
- Department of Otolaryngology–Head and Neck Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor, Ministry of Education, Nanning, China
| | - Anzhou Tang
- Department of Otolaryngology–Head and Neck Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor, Ministry of Education, Nanning, China
| | - Guangyao He
- Department of Otolaryngology–Head and Neck Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor, Ministry of Education, Nanning, China
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A Case of Radiation Recall Myositis and Neuropathy in Locally Advanced Rectal Cancer. Adv Radiat Oncol 2021; 6:100770. [PMID: 34557607 PMCID: PMC8445835 DOI: 10.1016/j.adro.2021.100770] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/12/2021] [Accepted: 07/28/2021] [Indexed: 11/20/2022] Open
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Enam N, Chou K, Stubblefield MD. Prevalence of function-limiting late effects in Hodgkin lymphoma survivors. PM R 2021; 14:811-817. [PMID: 34181821 DOI: 10.1002/pmrj.12662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 04/14/2021] [Accepted: 05/07/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Hodgkin lymphoma (HL) is highly curable, but survivors often develop function-limiting impairments. Screening guidelines for neuromuscular and musculoskeletal late effects are not as well recognized across medical disciplines. Early identification and management of functional late effects are instrumental in improving the longitudinal care of HL survivors. OBJECTIVE To define the prevalence of neuromuscular, musculoskeletal, visceral, oncologic, and other late effects affecting function and quality of life (QOL) in HL survivors. DESIGN A retrospective cohort analysis. SETTING Outpatient cancer rehabilitation clinic. PARTICIPANTS One hundred HL survivors. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Prevalence of neuromuscular, musculoskeletal, visceral, oncologic, and other late effects contributing to functional impairment and disability in HL survivors. RESULTS Among the 100 HL survivors, 43% received chemotherapy, 94% radiation therapy, and 38% a combination of chemo-radiation for their initial cancer treatment. Nearly all HL survivors were diagnosed with myelopathy (83%), radiculoplexopathy (93%), mononeuropathy (95%), and localized myopathy (93%). Musculoskeletal sequelae included dropped head syndrome (83%), cervicalgia (79%), shoulder girdle dysfunction (73%), and dysphagia (42%). Visceral disorders included cardiovascular (70%), pulmonary (44%), endocrine (63%), gastrointestinal (29%), and genitourinary (11%) dysfunction. Lymphedema affected 21% of survivors and 30% had a history of a secondary malignancy. Pain (71%), fatigue (45%), and dyspnea (43%) were major function-limiting impairments. Nearly all (95%) of survivors were referred to at least one therapy discipline including physical therapy, occupational therapy, speech and language pathology, and/or lymphedema therapy. CONCLUSION Neuromuscular, musculoskeletal, visceral, oncologic, and other late effects are extremely common in HL survivors seeking physiatric evaluation. Multiple function-limiting disorders can coexist in HL survivors with the potential to severely compromise function and QOL. Safe and effective rehabilitation may depend on the physiatrist's ability to identify, evaluate, and manage the multitude of complex and often interrelated functional late effects seen in HL survivors.
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Affiliation(s)
- Nabela Enam
- Department of Physical Medicine & Rehabilitation, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Kathy Chou
- Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Michael D Stubblefield
- Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey, USA.,Kessler Institute for Rehabilitation, West Orange, New Jersey, USA
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8
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Ando J, Ueno Y, Yasuda H, Ando M, Edahiro Y, Honda T, Takanashi M, Taniguchi D, Hattori N, Komatsu N. Radiation-Induced Myopathy Developing in a Hodgkin Lymphoma Patient: An Autopsy Case with Systemic Muscle Sampling. Case Rep Oncol 2021; 14:338-342. [PMID: 33776726 PMCID: PMC7983573 DOI: 10.1159/000512070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 10/05/2020] [Indexed: 11/19/2022] Open
Abstract
Radiation-induced myopathy (RIM) is a rare complication occurring years after radiotherapy. RIM basically occurs within the irradiation field, but some cases have been reported to be accommodated by myopathy outside the irradiation field, and the actual extent of RIM is obscure. The presented case also showed decreased MMT scores and abnormal needle electromyography results in the muscles outside the irradiated field, and the patient was initially thought to have RIM both within and outside the irradiated field. However, while systemic postmortem muscle sampling revealed prominent myopathy in line with RIM in the irradiated muscles, only mild myogenic changes that could be explained by other causes such as age-related sarcopenia, radiculopathy, and disuse atrophy were observed in the non-irradiated muscles. The number of biopsy sites in live patients is limited due to the invasive nature of the procedure, but we were privileged to systemically evaluate the extent of myopathy through multiple muscle sampling including muscles both inside and outside of the irradiation field because this was an autopsy case. Through the presented case, we conclude that RIM is a phenomenon most probably limited to the muscles within the irradiated field, and myopathy outside the irradiation is due to other causes.
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Affiliation(s)
- Jun Ando
- Department of Hematology, Juntendo University School of Medicine, Tokyo, Japan
| | - Yuji Ueno
- Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan
| | - Hajime Yasuda
- Department of Hematology, Juntendo University School of Medicine, Tokyo, Japan
| | - Miki Ando
- Department of Hematology, Juntendo University School of Medicine, Tokyo, Japan
| | - Yoko Edahiro
- Department of Hematology, Juntendo University School of Medicine, Tokyo, Japan
| | - Tadahiro Honda
- Department of Hematology, Juntendo University School of Medicine, Tokyo, Japan
| | - Masashi Takanashi
- Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan
| | - Daisuke Taniguchi
- Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan
| | - Nobutaka Hattori
- Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan
| | - Norio Komatsu
- Department of Hematology, Juntendo University School of Medicine, Tokyo, Japan
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9
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Oishi T, Ryan CS, Vazquez Do Campo R, Laughlin RS, Rubin DI. Quantitative analysis of myokymic discharges in radiation versus nonradiation cases. Muscle Nerve 2021; 63:861-867. [PMID: 33675544 DOI: 10.1002/mus.27219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 01/01/2021] [Accepted: 03/02/2021] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Myokymic discharges are classically associated with nerve injury from prior radiation but may occur in other neuromuscular disorders. Using quantitative analysis we aimed to identify the spectrum of conditions in which myokymic discharges are present and determine if there are electrophysiological features that distinguish postradiation from nonradiation causes of myokymia. METHODS We reviewed the clinical history of all patients examined in our electromyography labs with myokymic discharges recorded from June 2017 to February 2020. Quantitative analysis of each myokymic discharge was performed using a custom MATLAB script, assessing features such as burst frequency, spikes per burst, and burst regularity. RESULTS Eighty-eight distinct myokymic discharges (70 patients) were analyzed: 51 postradiation recordings from 35 patients and 37 recordings from 35 nonradiation patients. The diagnostic spectrum of nonradiation cases was diverse, with common causes being median neuropathy (n = 8), cervical (n = 7), and lumbar (n = 5) radiculopathy, and motor neuron disease (n = 5). On quantitative analysis, postradiation myokymia had an increased burst-to-silence ratio (median, 0.29; nonradiation, 0.08) and greater peak number (median, 15; nonradiation, 7). Except for one patient with hereditary peripheral nerve hyperexcitability, all patients who had two or more muscles demonstrating myokymic discharges belonged to postradiation group. CONCLUSIONS Myokymic discharges can be seen in diverse neuromuscular conditions; most common in our cohort was chronic median neuropathy. Postradiation myokymia appears to have distinguishing morphological features when quantitatively analyzed compared with nonradiation cases.
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Affiliation(s)
- Tatsuya Oishi
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Conor S Ryan
- Noran Neurological Institute, Minneapolis, Minnesota, USA
| | | | | | - Devon I Rubin
- Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA
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10
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Vicente E, Vujaskovic Z, Jackson IL. A Systematic Review of Metabolomic and Lipidomic Candidates for Biomarkers in Radiation Injury. Metabolites 2020; 10:E259. [PMID: 32575772 PMCID: PMC7344731 DOI: 10.3390/metabo10060259] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/09/2020] [Accepted: 06/13/2020] [Indexed: 12/16/2022] Open
Abstract
A large-scale nuclear event has the ability to inflict mass casualties requiring point-of-care and laboratory-based diagnostic and prognostic biomarkers to inform victim triage and appropriate medical intervention. Extensive progress has been made to develop post-exposure point-of-care biodosimetry assays and to identify biomarkers that may be used in early phase testing to predict the course of the disease. Screening for biomarkers has recently extended to identify specific metabolomic and lipidomic responses to radiation using animal models. The objective of this review was to determine which metabolites or lipids most frequently experienced perturbations post-ionizing irradiation (IR) in preclinical studies using animal models of acute radiation sickness (ARS) and delayed effects of acute radiation exposure (DEARE). Upon review of approximately 65 manuscripts published in the peer-reviewed literature, the most frequently referenced metabolites showing clear changes in IR induced injury were found to be citrulline, citric acid, creatine, taurine, carnitine, xanthine, creatinine, hypoxanthine, uric acid, and threonine. Each metabolite was evaluated by specific study parameters to determine whether trends were in agreement across several studies. A select few show agreement across variable animal models, IR doses and timepoints, indicating that they may be ubiquitous and appropriate for use in diagnostic or prognostic biomarker panels.
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Affiliation(s)
| | | | - Isabel L. Jackson
- Division of Translational Radiation Sciences, Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD 21201, USA; (E.V.); (Z.V.)
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11
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Oishi T, Kogelschatz CJ, Young NP, Hoffmann EM, Staff NP, Visscher SL, Borah BJ, Krauss WE, Arumaithurai K, Shelly S, Ansell SM, Klein CJ. Expanded neuromuscular morbidity in Hodgkin lymphoma after radiotherapy. Brain Commun 2020; 2:fcaa050. [PMID: 32954302 PMCID: PMC7425393 DOI: 10.1093/braincomms/fcaa050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 03/26/2020] [Accepted: 04/02/2020] [Indexed: 12/30/2022] Open
Abstract
Our study aims to quantitate neuromuscular morbidity from radiotherapy in Hodgkin lymphoma including: (i) frequency and (ii) time of onsets for neurological localizations; (iii) degree of disabilities and (iv) number of clinical visits compared to cardiopulmonary Hodgkin lymphoma-radiation complications. Medical records from Mayo Health systems were retrieved; identifying neuromuscular radiation treated Hodgkin lymphoma-complications from 1 January 1994 to 31 December 2016. Of an estimated 4100 post-radiotherapy Hodgkin lymphoma patients, 4.6% (189) were identified with complications. Mean latency to physician visit for symptoms was 23.7 years (range: 1-50). Most commonly identified complications included: head drop 10% (19) with or without myopathy, myopathy 39% (73), plexopathy 29% (54), myelopathy 27% (51) and polyradiculopathy 13% (24). Other findings included benign and malignant nerve sheath tumours 5% (9), phrenic and long thoracic mononeuropathies 7% (14) and compressive spinal meningioma 2% (4). Patients frequently had multiple coexisting complications (single = 76% [144], double = 17% [33], triple = 4% [8], quadruple = 2% [4]). Cardiac 28% (53) and pulmonary 15% (29) complications were also seen in these patients. History of Hodgkin lymphoma was initially overlooked by neurologists (14.3%, 48/336 clinical notes). Hospital and outpatient visits for complications were frequent: neuromuscular 19% (77/411) versus cardiopulmonary 30% (125/411). Testing was largely exclusionary, except when imaging identified secondary malignancy. Modified Rankin score at diagnosis varied: 0-1 (55.8%), 2-3 (5.8%) and 4-5 (38.3%). Neuromuscular complications among post-radiation Hodgkin lymphoma are diverse, occurring in ∼1 of 20 having markedly delayed onsets often eluding diagnosis. Frequent care visits and major morbidity are common. Survivorship recommendations should recognize the diverse neurological complications.
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Affiliation(s)
- Tatsuya Oishi
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - Cory J Kogelschatz
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA.,Intermountain Neurosciences Institute, Murray, UT 84107, USA
| | - Nathan P Young
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Nathan P Staff
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - Sue L Visscher
- Center of the Science of Health Care Delivery, Mayo Clinic, Rochester, MN 55905, USA
| | - Bijan J Borah
- Center of the Science of Health Care Delivery, Mayo Clinic, Rochester, MN 55905, USA
| | - William E Krauss
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Shahar Shelly
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Christopher J Klein
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA.,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA
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12
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Amorim NML, Kee A, Coster ACF, Lucas C, Bould S, Daniel S, Weir JM, Mellett NA, Barbour J, Meikle PJ, Cohn RJ, Turner N, Hardeman EC, Simar D. Irradiation impairs mitochondrial function and skeletal muscle oxidative capacity: significance for metabolic complications in cancer survivors. Metabolism 2020; 103:154025. [PMID: 31765667 DOI: 10.1016/j.metabol.2019.154025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 11/19/2019] [Accepted: 11/21/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Metabolic complications are highly prevalent in cancer survivors treated with irradiation but the underlying mechanisms remain unknown. METHODS Chow or high fat-fed C57Bl/6J mice were irradiated (6Gy) before investigating the impact on whole-body or skeletal muscle metabolism and profiling their lipidomic signature. Using a transgenic mouse model (Tg:Pax7-nGFP), we isolated muscle progenitor cells (satellite cells) and characterised their metabolic functions. We recruited childhood cancer survivors, grouped them based on the use of total body irradiation during their treatment and established their lipidomic profile. RESULTS In mice, irradiation delayed body weight gain and impaired fat pads and muscle weights. These changes were associated with impaired whole-body fat oxidation in chow-fed mice and altered ex vivo skeletal muscle fatty acid oxidation, potentially due to a reduction in oxidative fibres and reduced mitochondrial enzyme activity. Irradiation led to fasting hyperglycaemia and impaired glucose uptake in isolated skeletal muscles. Cultured satellite cells from irradiated mice showed decreased fatty acid oxidation and reduced glucose uptake, recapitulating the host metabolic phenotype. Irradiation resulted in a remodelling of lipid species in skeletal muscles, with the extensor digitorum longus muscle being particularly affected. A large number of lipid species were reduced, with several of these species showing a positive correlation with mitochondrial enzymes activity. In cancer survivors exposed to irradiation, we found a similar decrease in systemic levels of most lipid species, and lipid species that increased were positively correlated with insulin resistance (HOMA-IR). CONCLUSION Irradiation leads to long-term alterations in body composition, and lipid and carbohydrate metabolism in skeletal muscle, and affects muscle progenitor cells. Such changes result in persistent impairment of metabolic functions, providing a new mechanism for the increased prevalence of metabolic diseases reported in irradiated individuals. In this context, changes in the lipidomic signature in response to irradiation could be of diagnostic value.
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Affiliation(s)
- Nadia M L Amorim
- Cellular and Genetic Medicine Unit, School of Medical Sciences, UNSW Sydney, Sydney, Australia
| | - Anthony Kee
- Cellular and Genetic Medicine Unit, School of Medical Sciences, UNSW Sydney, Sydney, Australia
| | - Adelle C F Coster
- School of Mathematics and Statistics, UNSW Sydney, Sydney, Australia
| | - Christine Lucas
- Cellular and Genetic Medicine Unit, School of Medical Sciences, UNSW Sydney, Sydney, Australia
| | - Sarah Bould
- Cellular and Genetic Medicine Unit, School of Medical Sciences, UNSW Sydney, Sydney, Australia
| | - Sara Daniel
- Mechanisms of Disease and Translational Research, School of Medical Sciences, UNSW Sydney, Sydney, Australia
| | - Jacquelyn M Weir
- Metabolomics Laboratory, Baker IDI, Heart and Diabetes Institute, Melbourne, Australia
| | - Natalie A Mellett
- Metabolomics Laboratory, Baker IDI, Heart and Diabetes Institute, Melbourne, Australia
| | - Jayne Barbour
- Mitochondrial Bioenergetics Lab, Department of Pharmacology, School of Medical Sciences, UNSW Sydney, Sydney, Australia
| | - Peter J Meikle
- Metabolomics Laboratory, Baker IDI, Heart and Diabetes Institute, Melbourne, Australia
| | - Richard J Cohn
- School of Women's and Children's Health, UNSW Sydney, Randwick, Australia; Kids Cancer Centre, Sydney Children's Hospital Network, Randwick, Australia
| | - Nigel Turner
- Mitochondrial Bioenergetics Lab, Department of Pharmacology, School of Medical Sciences, UNSW Sydney, Sydney, Australia
| | - Edna C Hardeman
- Cellular and Genetic Medicine Unit, School of Medical Sciences, UNSW Sydney, Sydney, Australia.
| | - David Simar
- Mechanisms of Disease and Translational Research, School of Medical Sciences, UNSW Sydney, Sydney, Australia.
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13
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DiFrancesco T, Khanna A, Stubblefield MD. Clinical Evaluation and Management of Cancer Survivors with Radiation Fibrosis Syndrome. Semin Oncol Nurs 2020; 36:150982. [PMID: 32008860 DOI: 10.1016/j.soncn.2019.150982] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To define radiation fibrosis and radiation fibrosis syndrome; review the basics of radiotherapy, the pathophysiology of radiation injury, and the principles of clinical evaluation and management of the common late effects resulting from radiation therapy for cancer treatment. DATA SOURCES Peer-reviewed journal articles, book chapters, Internet. CONCLUSION There is no cure for radiation fibrosis syndrome, but supportive treatment of its clinical sequelae can potentially result in improved function and quality of life. IMPLICATIONS FOR NURSING PRACTICE The sequelae of radiation fibrosis syndrome can often be improved with early detection and supportive care by a multidisciplinary team including cancer rehabilitation physiatrists, oncologists, oncology nurses, nurse practitioners, physical therapists, occupational therapists, and speech and language pathologists.
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Affiliation(s)
- Tanya DiFrancesco
- PGY-4 Physical Medicine & Rehabilitation, Kingsbrook Rehabilitation Institute, Brooklyn, NY
| | - Ashish Khanna
- Cancer Rehabilitation Medicine, The Kessler Institute for Rehabilitation, West Orange, NJ; Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ
| | - Michael D Stubblefield
- Cancer Rehabilitation Medicine, The Kessler Institute for Rehabilitation, West Orange, NJ.
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14
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The Changing Role of Electrodiagnostic Testing in Cancer Rehabilitation. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2018. [DOI: 10.1007/s40141-018-0180-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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15
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Kaido M, Yuasa Y, Ikeda H. [A survivor of Hodgkin lymphoma manifesting dropped head syndrome as a late-onset complication of radiotherapy: a case report]. Rinsho Shinkeigaku 2018; 58:308-313. [PMID: 29710025 DOI: 10.5692/clinicalneurol.cn-001158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We report the case of a 50-year-old female survivor of Hodgkin lymphoma (HL), who developed dropped head syndrome (DHS). The patient was diagnosed with HL at 20 years of age, and underwent chemo-radiotherapy, which led to complete remission. Undergoing supplemental therapy for post-radiation hypothyroidism, she had twin babies. She noticed white stains on her neck at the age of 30, and the decolored area gradually expanded. Sixteen years after the radiotherapy (RT), her posterior neck muscle strength began to decline. She had to make considerable efforts to keep her neck straight, and came to experience a severe pain in the neck and shoulders. The patient visited our department due to DHS at the age of 50. She had leukoderma, muscle weakness, and muscle atrophy in the neck and para-spinal region, which were consistent with the area of RT. The strength was preserved in the other parts of the muscle, including the proximal upper limbs. Sensory nerve disorder was not detected. The serum creatine kinase level was slightly elevated. Cervical spine or cervical cord disease that can cause DHS was not detected by MRI examination. The MRI and CT images revealed marked atrophy in the posterior neck and para-spinal muscles. The electromyogram revealed myopathic changes, and the cause of her DHS was diagnosed as radiation-induced myopathy. DHS is a well-known late-onset radiation injury, and Japanese cases have been reported in elderly persons with laryngeal or lung cancer. However, there have been no Japanese case reports of radiation-induced DHS due to RT against HL in younger persons. The patient had visited several clinics and hospitals before she came to our hospital, but RT-induced DHS had been overlooked. Greater recognition and consideration is required for DHS as one of the various issues arising after long passage of HL survivors.
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Affiliation(s)
- Misako Kaido
- Department of Neurology, Sakai City Medical Center
| | | | - Hiroshi Ikeda
- Department of Radiotherapy, Sakai City Medical Center
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16
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Abstract
PURPOSE OF REVIEW Understanding the mechanisms and abnormalities of respiratory function in neuromuscular disease is critical to supporting the patient and maintaining ventilation in the face of acute or chronic progressive impairment. RECENT FINDINGS Retrospective clinical studies reviewing the care of patients with Guillain-Barré syndrome and myasthenia have shown a disturbingly high mortality following step-down from intensive care. This implies high dependency and rehabilitation management is failing despite evidence that delayed improvement can occur with long-term care. A variety of mechanisms of phrenic nerve impairment have been recognized with newer investigation techniques, including EMG and ultrasound. Specific treatment for progressive neuromuscular and muscle disease has been increasingly possible particularly for the treatment of myasthenia, metabolic myopathies, and Duchenne muscular dystrophy. For those conditions without specific treatment, it has been increasingly possible to support ventilation in the domiciliary setting with newer techniques of noninvasive ventilation and better airway clearance. There remained several areas of vigorous debates, including the role for tracheostomy care and the place of respiratory muscle training and phrenic nerve/diaphragm pacing. SUMMARY Recent studies and systematic reviews have defined criteria for anticipating, recognizing, and managing ventilatory failure because of acute neuromuscular disease. The care of patients requiring long-term noninvasive ventilatory support for chronic disorders has also evolved. This has resulted in significantly improved survival for patients requiring domiciliary ventilatory support.
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17
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Curtin M, Piggott RP, Murphy EP, Munigangaiah S, Baker JF, McCabe JP, Devitt A. Spinal Metastatic Disease: A Review of the Role of the Multidisciplinary Team. Orthop Surg 2017; 9:145-151. [PMID: 28544780 DOI: 10.1111/os.12334] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 03/02/2017] [Indexed: 12/16/2022] Open
Abstract
Historically, a simple approach centered on palliation was applicable to the majority of patients with metastatic spinal disease. With advances in diagnosis and treatment, a more complicated algorithm has devolved requiring a multidisciplinary approach with institutional commitment and support. We performed a database review including pertinent articles exploring the multidisciplinary management of spinal metastatic disease. The wide variation in clinical presentation and tumor response to treatment necessitates a multidisciplinary approach that integrates the diagnosis and treatment of the cancer, symptom management, and rehabilitation for optimal care of patients with spinal metastases. Advances in the field of radiology have led to earlier and more focused diagnosis of spinal metastasis and acts to guide therapy. Advances in surgical techniques, neurophysiologic monitoring, and anesthetic expertise have allowed surgeons to perform more extensive procedures leading to improved outcomes and reduced morbidity. Radiation oncology input that is essential as external beam radiation therapy can provide significant pain relief. Non-operative measures may include bisphosphonate infusions, management of complications (e.g. hypercalcemia of malignancy), monoclonal antibody infusions, and chemotherapy if indicated in the treatment of the primary malignancy. Input from psychology services is necessary to address the biopsychosocial ramifications of spinal metastasis. Allied health professionals in the form of physiotherapists, social workers, and dieticians also contribute in maximizing patients' quality of life and well-being.
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Affiliation(s)
- Mark Curtin
- Department of Trauma and Orthopaedic Surgery, University College Hospital Galway, Saolta Hospital Group, Galway, Ireland
| | - Robert P Piggott
- Department of Trauma and Orthopaedic Surgery, University College Hospital Galway, Saolta Hospital Group, Galway, Ireland
| | - Evelyn P Murphy
- Department of Trauma and Orthopaedic Surgery, University College Hospital Galway, Saolta Hospital Group, Galway, Ireland
| | - Sudarshan Munigangaiah
- Department of Trauma and Orthopaedic Surgery, University College Hospital Galway, Saolta Hospital Group, Galway, Ireland
| | - Joseph F Baker
- Department of Trauma and Orthopaedic Surgery, University College Hospital Galway, Saolta Hospital Group, Galway, Ireland
| | - John P McCabe
- Department of Trauma and Orthopaedic Surgery, University College Hospital Galway, Saolta Hospital Group, Galway, Ireland
| | - Aiden Devitt
- Department of Trauma and Orthopaedic Surgery, University College Hospital Galway, Saolta Hospital Group, Galway, Ireland
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18
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Naddaf E, Milone M. Hereditary myopathies with early respiratory insufficiency in adults. Muscle Nerve 2017; 56:881-886. [PMID: 28181274 DOI: 10.1002/mus.25602] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 01/31/2017] [Accepted: 02/04/2017] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Hereditary myopathies with early respiratory insufficiency as a predominant feature of the clinical phenotype are uncommon and underestimated in adults. METHODS We reviewed the clinical and laboratory data of patients with hereditary myopathies who demonstrated early respiratory insufficiency before the need for ambulatory assistance. Only patients with disease-causing mutations or a specific histopathological diagnosis were included. Patients with cardiomyopathy were excluded. RESULTS We identified 22 patients; half had isolated respiratory symptoms at onset. The diagnosis of the myopathy was often delayed, resulting in delayed ventilatory support. The most common myopathies were adult-onset Pompe disease, myofibrillar myopathy, multi-minicore disease, and myotonic dystrophy type 1. Single cases of laminopathy, MELAS (mitochondrial encephalomyopathy with lactic acidosis and strokelike events), centronuclear myopathy, and cytoplasmic body myopathy were identified. CONCLUSION We highlighted the most common hereditary myopathies associated with early respiratory insufficiency as the predominant clinical feature, and underscored the importance of a timely diagnosis for patient care. Muscle Nerve 56: 881-886, 2017.
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Affiliation(s)
- Elie Naddaf
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota, 55905, USA
| | - Margherita Milone
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota, 55905, USA
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19
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Sih M, Soliven B, Mathenia N, Jacobsen J, Rezania K. Head-drop: A frequent feature of late-onset myasthenia gravis. Muscle Nerve 2017; 56:441-444. [PMID: 28000322 DOI: 10.1002/mus.25526] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 12/12/2016] [Accepted: 12/14/2016] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Head-drop is often encountered in myasthenia gravis (MG) patients, but its frequency and clinical course have not been studied systematically. METHODS In a retrospective study of a cohort of MG patients seen over a period of 11 years in a tertiary medical center, we assessed the clinical characteristics of patients who had head-drop. RESULTS Of 146 generalized MG patients, 15 had head-drop during the course of their disease. Head-drop patients had older age of onset than those who did not have head-drop (mean age of onset 59.1 vs. 42.3 years) and were predominantly men. Head-drop was present in 23% of patients > 60 versus 6% of those < 60 years, and it improved in 9 of 11 patients with treatment directed to generalized MG. CONCLUSIONS Head-drop is a common, treatment-responsive manifestation of late-onset MG. Muscle Nerve 56: 441-444, 2017.
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Affiliation(s)
- Marvin Sih
- Department of Neurology, University of Chicago Medical Center, 5841 S. Maryland Avenue, MC 2030, Chicago, Illinois, 60637
| | - Betty Soliven
- Department of Neurology, University of Chicago Medical Center, 5841 S. Maryland Avenue, MC 2030, Chicago, Illinois, 60637
| | - Nicholas Mathenia
- Department of Neurology, University of Chicago Medical Center, 5841 S. Maryland Avenue, MC 2030, Chicago, Illinois, 60637
| | - John Jacobsen
- Department of Neurology, University of Chicago Medical Center, 5841 S. Maryland Avenue, MC 2030, Chicago, Illinois, 60637
| | - Kourosh Rezania
- Department of Neurology, University of Chicago Medical Center, 5841 S. Maryland Avenue, MC 2030, Chicago, Illinois, 60637
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20
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Florczynski MM, Sanatani MS, Mai L, Fisher B, Moulin DE, Cao J, Louie AV, Pope JE, Leung E. Severe myositis of the hip flexors after pre-operative chemoradiation therapy for locally advanced rectal cancer: case report. BMC Cancer 2016; 16:243. [PMID: 27000107 PMCID: PMC4802822 DOI: 10.1186/s12885-016-2269-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 03/10/2016] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The use of neoadjuvant radiation therapy and chemotherapy in the treatment of locally advanced rectal adenocarcinoma has been shown to reduce disease recurrence when combined with surgery and adjuvant chemotherapy. We report a case of a patient who developed a debilitating bilateral myopathy of the hip flexors after successful treatment for rectal cancer. To the best of our knowledge, this is the first such complication from radiation therapy reported in a patient with colorectal cancer. The disproportionate severity of our patient's myopathy relative to the dose of radiation used also makes this case unique among reports of neuromuscular complications from radiation therapy. CASE PRESENTATION The patient is a 65-year-old male with node negative, high-grade adenocarcinoma of the rectum penetrating through the distal rectal wall. He underwent neoadjuvant concurrent pelvic radiation therapy and capecitabine-based chemotherapy, followed by abdominoperineal resection and post-operative FOLFOX chemotherapy. Five months post-completion of pelvic radiotherapy and 2 months after the completion of adjuvant chemotherapy, he presented with bilateral weakness of the iliopsoas muscles and severe pain radiating to the groin. The patient improved with 40 mg/d of prednisone, which was gradually tapered to 2 mg/d over 6 months, with substantial recovery of muscle strength and elimination of pain. CONCLUSIONS The timing, presentation and response of our patient's symptoms to corticosteroids are most consistent with a radiation recall reaction. Radiation recall is a phenomenon whereby previously irradiated tissue becomes vulnerable to toxicity by subsequent systemic therapy and is rarely associated with myopathies. Radiation recall should be considered a potential complication of neoadjuvant radiation therapy for rectal cancer, and for ongoing research into the optimization of treatment for these patients. Severe myopathies caused by radiation recall may be fully reversible with corticosteroid treatment.
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Affiliation(s)
- Matthew M Florczynski
- Departments of Oncology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Michael S Sanatani
- Departments of Oncology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Lauren Mai
- Departments of Neurology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Barbara Fisher
- Departments of Oncology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Dwight E Moulin
- Departments of Neurology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Jeffrey Cao
- Departments of Oncology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Alexander V Louie
- Departments of Oncology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Janet E Pope
- Departments of Rheumatology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Eric Leung
- Departments of Oncology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada. .,Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
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21
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Kim J, Shin ES, Kim JE, Yoon SP, Kim YS. Neck muscle atrophy and soft-tissue fibrosis after neck dissection and postoperative radiotherapy for oral cancer. Radiat Oncol J 2015; 33:344-9. [PMID: 26756035 PMCID: PMC4707218 DOI: 10.3857/roj.2015.33.4.344] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 12/03/2015] [Accepted: 12/08/2015] [Indexed: 11/26/2022] Open
Abstract
Late complications of head and neck cancer survivors include neck muscle atrophy and soft-tissue fibrosis. We present an autopsy case of neck muscle atrophy and soft-tissue fibrosis (sternocleidomastoid, omohyoid, digastric, sternohyoid, sternothyroid, and platysma muscles) within the radiation field after modified radical neck dissection type I and postoperative radiotherapy for floor of mouth cancer. A 70-year-old man underwent primary tumor resection of the left floor of mouth, left marginal mandibulectomy, left modified radical neck dissection type I, and reconstruction with a radial forearm free flap. The patient received adjuvant radiotherapy. The dose to the primary tumor bed and involved neck nodes was 63 Gy in 35 fractions over 7 weeks. Areas of subclinical disease (left lower neck) received 50 Gy in 25 fractions over 5 weeks. Adjuvant chemotherapy was not administered.
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Affiliation(s)
- Jinu Kim
- Department of Anatomy, Jeju National University School of Medicine, Jeju, Korea.; Department of Biomedicine & Drug Development, Jeju National University, Jeju, Korea
| | - Eun Seow Shin
- Medical Course, Jeju National University School of Medicine, Jeju, Korea
| | - Jeong Eon Kim
- Medical Course, Jeju National University School of Medicine, Jeju, Korea
| | - Sang Pil Yoon
- Department of Anatomy, Jeju National University School of Medicine, Jeju, Korea
| | - Young Suk Kim
- Department of Radiation Oncology, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
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Witting N, Andersen LK, Vissing J. Axial myopathy: an overlooked feature of muscle diseases. Brain 2015; 139:13-22. [DOI: 10.1093/brain/awv332] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 09/16/2015] [Indexed: 12/21/2022] Open
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23
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Zhang LL, Mao YP, Zhou GQ, Tang LL, Qi ZY, Lin L, Yao JJ, Ma J, Lin AH, Sun Y. The Evolution of and Risk Factors for Neck Muscle Atrophy and Weakness in Nasopharyngeal Carcinoma Treated With Intensity-Modulated Radiotherapy: A Retrospective Study in an Endemic Area. Medicine (Baltimore) 2015; 94:e1294. [PMID: 26252307 PMCID: PMC4616570 DOI: 10.1097/md.0000000000001294] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of this study was to investigate the evolution of sternocleidomastoid muscle (SCM) atrophy in nasopharyngeal carcinoma (NPC) patients following intensity-modulated radiotherapy (IMRT), and the relationship between SCM atrophy and neck weakness.Data were retrospectively analyzed from 223 biopsy-proven NPC patients with no distant metastasis who underwent IMRT with or without chemotherapy. The volume of SCM was measured on pretreatment magnetic resonance imaging (MRI), and MRIs were conducted 1, 2, and 3 years after the completion of IMRT. Change in SCM volume was calculated and classified using the late effects of normal tissues-subjective, objective, management, and analytic system. The grade of neck muscle weakness, classified by the Common Terminology Criteria for Adverse Events V 3.0, was measured 3 years after the completion of IMRT.The average SCM atrophy ratio was -10.97%, -18.65%, and -22.25% at 1, 2, and 3 years postirradiation, respectively. Multivariate analysis indicated N stage and the length of time after IMRT were independent prognostic variables. There were significant associations between the degree of SCM atrophy and neck weakness.Radical IMRT can cause significant SCM atrophy in NPC patients. A more advanced N stage was associated with more severe SCM atrophy, but no difference was observed between N2 and N3. SCM atrophy progresses over time during the 3 years following IMRT. Grade of SCM atrophy is significantly associated with neck weakness.
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Affiliation(s)
- Lu-Lu Zhang
- From the Department of Radiation Oncology (L-LZ, Y-PM, G-QZ, L-LT, Z-YQ, LL, J-JY, JM, YS), State Key Laboratory of Oncology in Southern China, Cancer Center, Sun Yat-sen University; and Department of Medical Statistics and Epidemiology (A-HL), School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
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Seidel C, Kuhnt T, Kortmann RD, Hering K. Radiation-induced camptocormia and dropped head syndrome: Review and case report of radiation-induced movement disorders. Strahlenther Onkol 2015; 191:765-70. [PMID: 26072168 DOI: 10.1007/s00066-015-0857-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 05/13/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND In recent years, camptocormia and dropped head syndrome (DHS) have gained attention as particular forms of movement disorders. Camptocormia presents with involuntary forward flexion of the thoracolumbar spine that typically increases during walking or standing and may severely impede walking ability. DHS is characterized by weakness of the neck extensors and a consecutive inability to extend the neck; in severe cases the head is fixed in a "chin to chest position." Many diseases may underlie these conditions, and there have been some reports about radiation-induced camptocormia and DHS. METHODS A PubMed search with the keywords "camptocormia," "dropped head syndrome," "radiation-induced myopathy," "radiation-induced neuropathy," and "radiation-induced movement disorder" was carried out to better characterize radiation-induced movement disorders and the radiation techniques involved. In addition, the case of a patient developing camptocormia 23 years after radiation therapy of a non-Hodgkin's lymphoma of the abdomen is described. RESULTS In total, nine case series of radiation-induced DHS (n = 45 patients) and-including our case-three case reports (n = 3 patients) about radiogenic camptocormia were retrieved. Most cases (40/45 patients) occurred less than 15 years after radiotherapy involving extended fields for Hodgkin's disease. CONCLUSION The use of wide radiation fields including many spinal segments with paraspinal muscles may lead to radiation-induced movement disorders. If paraspinal muscles and the thoracolumbar spine are involved, the clinical presentation can be that of camptocormia. DHS may result if there is involvement of the cervical spine. To prevent these disorders, sparing of the spine and paraspinal muscles is desirable.
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Affiliation(s)
- Clemens Seidel
- Department of Radiotherapy and Radiation Oncology, Leipzig University, Stephanstrasse 9a, 04103, Leipzig, Germany.
| | - Thomas Kuhnt
- Department of Radiotherapy and Radiation Oncology, Leipzig University, Stephanstrasse 9a, 04103, Leipzig, Germany
| | - Rolf-Dieter Kortmann
- Department of Radiotherapy and Radiation Oncology, Leipzig University, Stephanstrasse 9a, 04103, Leipzig, Germany
| | - Kathrin Hering
- Department of Radiotherapy and Radiation Oncology, Leipzig University, Stephanstrasse 9a, 04103, Leipzig, Germany
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25
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Ghosh PS, Milone M. Camptocormia as presenting manifestation of a spectrum of myopathic disorders. Muscle Nerve 2015; 52:1008-12. [DOI: 10.1002/mus.24689] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Revised: 03/29/2015] [Accepted: 04/13/2015] [Indexed: 12/13/2022]
Affiliation(s)
- Partha S. Ghosh
- Department of Neurology; Boston Children's Hospital; Boston Massachusetts USA
- Department of Neurology; Mayo Clinic; 200 First Street SW Rochester Minnesota 55905 USA
| | - Margherita Milone
- Department of Neurology; Mayo Clinic; 200 First Street SW Rochester Minnesota 55905 USA
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